Snared suture trimmer

ABSTRACT

A method for closing a tissue puncture, where the method includes tensioning a suture loop disposed within a vascular tissue of a patient, the suture loop having two free ends and a knot disposed on one of the free end. Those two free ends are disposed through a suture snare comprising a snare. Following detachment of the suture snare from the two free ends, the knot is advanced to close the suture loop and a cutting member is advance towards the knot and the two free ends are cut.

CROSS-REFERENCE TO RELATED APPLICATIONS

This is a continuation of U.S. patent application Ser. No. 13/936,593,filed Jul. 8, 2013, and entitled “Snared Suture Trimmer”, which is adivisional of U.S. patent application Ser. No. 12/914,658, filed Oct.28, 2010, and entitled “Snared Suture Trimmer”, now issued as U.S. Pat.No. 8,480,691, which is a continuation of U.S. patent application Ser.No. 11/461,243, filed Jul. 31, 2006, and entitled “Snared SutureTrimmer,” now issued as U.S. Pat. No. 7,842,051 which is a continuationof U.S. patent application Ser. No. 10/860,443, filed Jun. 3, 2004, andentitled “Snared Suture Trimmer”, now issued as U.S. Pat. No. 7,147,646,which is a divisional application of U.S. patent application Ser. No.10/004,817, filed Dec. 7, 2001, and entitled “Snared Suture Trimmer”,now issued as U.S. Pat. No. 6,746,457, the disclosures of each areincorporated herein by this reference.

BACKGROUND OF THE INVENTION

1. The Field of the Invention

The present invention relates generally to surgical devices and methods.More particularly, the present invention relates to the construction anduse of devices for advancing surgical knot(s) and trimming the ends ofthe suture adjacent to the knot(s). Such a device is to be referred toas a “suture trimmer”, as used through the appended specification.

2. The Relevant Technology

The closing of incision and wounds using suture is a preferred techniqueof surgeons and many other physicians. While other techniques are nowavailable such as stapling, the use of “tissue glues,” and the use ofcollagen for closing vascular punctures, the use of suture is oftenpreferred because it provides a reliable and tight closure of any wound.Additionally, if a suture is to fail, the surgeon will know immediately,this is unlike many of the other devices listed above which may not failuntil some time after the procedure.

While the suturing of a wound is a relatively straight forward procedurein most open surgical procedures, placement and tying of sutures inlaparoscopic and other minimally invasive procedures can be problematic.In order to provide for suturing under such circumstances, a variety ofdevices have been developed for the remote placement and tying of suturethrough cannulas under video observation. Usually, a sliding knot willbe formed in a suture loop, a tool known as a “knot pusher” such as thatshown in U.S. Pat. No. 5,797,929 the entirety of which is herebyincorporated by reference, is utilized to advance and position the knotand tighten the loop of suture.

Such knot pushing devices may also be utilized in recently developedtechniques for the remote suturing of vascular punctures. Punctures maybe formed in the femoral or other arteries to provide vascular accessfor performing angioplasty and other vascular procedures. Suchtechniques are described in U.S. Pat. No. 5,417,699 and U.S. Pat. No.5,527,322, the entireties of which are hereby incorporated by reference.Such methods result in the placement of a suture loop through tissue onopposite sides of the vascular puncture. Two free ends of the sutureloop are brought out through a tissue tract leading to the puncture, andthe ends may be externally tied by the treating physician.Alternatively, a knot forming device such as that shown in U.S. Pat. No.6,171,317, the entirety of which is hereby incorporated by reference,may be utilized to tie a knot.

Through the use of a knot pusher, such as that shown and described inU.S. Pat. No. 5,797,929, the entirety of which is hereby incorporated byreference, the knot may be advanced through the tissue tract so that itlies directly over the adventitial wall of the blood vessel.

After the knot has been advanced over the adventitial wall of the bloodvessel and tightened, the excess suture must be cut away. Typically, asurgeon may utilize a scalpel or a pair of scissors to cut the sutureends just below the exterior surface of the patient's skin.

A concern with this method is that by leaving lengths of suture withinthe wound may lead to irritation of the incision. More significantly, arelatively long suture end, extending from the knot at the vessel repairto the skin level, may act as a “wick” for infective microorganismswhich may be present at skin level. The wick would provide a conduit forthese microorganisms to travel from the skin surface to the vesselrepair, thereby leading to infection. Many times a surgeon cannot easilyshorten this cut length because the location of the knot is well belowthe patient's tissue and is not readily visible, therefore they can onlyshorten the suture to the point that they can visually see. Furtherstill, many surgical procedures are moving away from being open andtoward being minimally invasive wherein the procedure is performedwithin a small opening formed in the patient's tissue. As describedabove, many times the surgeon cannot see the vessel which they aretrying to close with the suture.

Therefore there is a need for a device that will enable a surgeon toadvance a knot and trim the excess suture from the knot without havingto visually see the knot.

BRIEF SUMMARY OF THE INVENTION

In one aspect of the invention there is provided a suture trimmer, thesuture trimmer including a shaft having a first end, a second end and abore extending axially therebetween, the shaft having an opening formedin the side adjacent the distal end. A fitting disposed on the distalend of the shaft, the fitting having an aperture formed therethrough,the aperture axially aligned with the bore of the lumen and incommunication with the opening formed in the shaft. The suture trimmerfurther includes a housing disposed on the proximal end of the shaft,the housing including a lever and biasing device, the lever coupled to acutting member slidably disposed within the bore of the shaft, thecutting member configured to be moved between a first position and asecond position, when disposed in the second position the cutting membercloses the opening formed in the side of the shaft.

In another aspect of the invention there is provided a method forclosing a suture loop, the method including the steps of tensioning asuture loop, the suture loop disposed within a patient and having twofree ends and a knot disposed on one of the free ends. The methodfurther includes disposing the two free ends of the suture through asuture trimming device. The method may further include the step ofadvancing a distal end of the suture trimming device to contact the knotand advance the knot to close the suture loop while holding at least oneend of the suture, and activating a cutting member within the suturetrimmer to cut the two free ends of the suture adjacent to the knot.

BRIEF DESCRIPTION OF THE DRAWINGS

The objects and advantages of the invention will become apparent fromthe following detailed description of preferred embodiments thereof inconnection with the accompanying drawings in which like numeralsdesignate like elements and in which:

FIG. 1 is a isometric view of an exemplary embodiment of a suturetrimmer in accordance with the present invention;

FIG. 2 is a partial cut-away isometric view of an exemplary embodimentof the suture trimmer in accordance with the present invention;

FIG. 3 is a partial cut-away isometric view of an exemplary embodimentof the suture trimmer in accordance with the present invention whereinthe cutting member has been deployed;

FIG. 4 is a isometric view of an exemplary embodiment of a fitting inaccordance with the present invention;

FIG. 5 is a cross-sectional view of the shaft, fitting, and cuttingmember of the suture cutter in accordance with the present invention;

FIG. 6 is a isometric view of a suture snare in accordance with thepresent invention;

FIG. 7 is a isometric view of the suture trimmer in accordance with thepresent invention wherein two free suture ends are disposed through thesuture snare;

FIG. 8 is an isometric view of the suture trimmer in accordance with thepresent invention illustrating the two free suture ends as disposedthrough fitting and exiting through an opening formed in the shaft;

FIG. 9 is an isometric view of the suture trimmer according to thepresent invention wherein the tip of the suture trimmer is beingutilized to advance at least one knot formed in the two free ends of thesuture; and

FIG. 10 is an isometric view of the suture trimmer in accordance withthe present invention wherein the cutting member has been deployed tocut the two free ends of the suture.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

In accordance with the present invention there is provided a suturetrimmer, the suture trimmer may be utilized by physicians in any of avariety of surgical procedures where suture loop has been formed intissue to close an incision or wound, or for any other purpose. Aslidable knot will be formed in the loop, and the suture trimmer is usedto engage and advance the knot over a free end of the suture to closethe loop. The knot can then be tightened by pulling on the other freeend of the suture. The free ends of the suture may then be trimmedadjacent to the knot by activating the cutting member of the suturetrimmer.

The suture trimmer in accordance with the present invention comprises anelongated, narrow diameter shaft suitable for use in remote proceduresperformed through percutaneous tissue punctures, such as vascularclosures, laproscopic and other minimally invasive procedures and thelike. Thus, the shaft of the suture trimmer may be embodied in manylengths to accommodate the various procedures for which the device maybe utilized. The diameter of the shaft will be sufficiently small tofacilitate the introduction through access sheaths, trocars, and thelike, as well as punctures through the tissue of a patient's body,herein referred to as a “tissue tract.” Typically the diameter of theshaft will range from about 4 French to about 10 French, more preferablythe diameter of the shaft may range from about 6 French to about 8French. The distal end of the shaft configured to engage and advance aslidable knot. A housing may be provided on the proximal end of theshaft wherein the housing forms a handle and retains a mechanism foractivating the cutting member disposed in the shaft.

It shall be appreciated that although the suture trimmer has beendescribed as being utilized in minimally invasive procedures, it iscontemplated that the suture trimmer may be utilized for many openprocedures that utilize suture to close vessels or wounds.

In a preferred embodiment a fitting will be provided at the distal endof the shaft. The fitting is preferably formed of a relatively hardmaterial to firmly engage the knot and permit smooth advancement of theknot. The fitting is typically a cylindrical element having a flat orslightly convex or concave front face. The fitting preferably has adiameter equal to or less than the diameter of the shaft. The fittingwill further included an aperture formed through an axis thereof and incommunication with a opening formed in the side of the shaft. The freeends of the suture may be drawn through the aperture and opening throughthe use of a suture snare. Alternatively, the fitting may include agroove in communication with the aperture and the opening formed in theshaft. The free ends of the suture may be received in the groove anddrawn therethrough, wherein, the free ends of the suture extend from theopening formed in the shaft, thereby eliminating the need for a snare. Alocking mechanism may be deployed to retain the suture within thegroove. The free ends of the suture extending from the opening formed inthe shaft enable the tensioning of the knot after advancement of theknot. In an alternative embodiment, the structure of the fittingdescribed herein may be integral with or formed from the shaft materialsuch that a separate fitting piece can be eliminated from the assemblyof the suture trimmer.

The shaft of the suture trimmer in accordance with the present inventionis preferably rigid, typically being formed from of a bio-compatiblematerial such as metal or plastic. Suitable metals include stainlesssteel, gold plated metals, silver plated metals, platinum or platinumplated metals, or titanium. It shall be understood that other metals maybe utilized if an appropriate bio-compatible coated was applied thereto.Suitable plastics include polycarbonate, polyvinyl chloride (PVC),nylon, or similar plastics. As will be described in greater detailbelow, the shaft may be formed of more than one component. It is furthercontemplated that the shaft may be constructed to provide a degree offlexibility which will enable the device to be utilized in a greaternumber of surgical procedures.

The housing may be constructed of a bio-compatible material such asmetal or plastic. Suitable metals include stainless steel, gold platedmetals, silver plated metals, platinum or platinum plated metals, ortitanium. It shall be understood that other metals may be utilized if anappropriate bio-compatible coated was applied thereto. Suitable plasticsinclude polycarbonate, polyvinyl chloride (PVC), nylon, or similarplastics. In a preferred embodiment the housing is constructed ofplastic.

Referring now to FIG. 1 there is shown an exemplary embodiment of thesuture trimmer in accordance with the present invention. As shown inFIG. 1, the suture trimmer 10 comprises a shaft assembly 21, a housing30, a fitting 50, and a suture snare 90. Each of which will be describedin greater detail below with respect to the appropriate figures.

Referring now to FIG. 2, there is shown a partial cut-away view of anexemplary embodiment of the suture trimmer 10 in accordance with thepresent invention. As shown, the shaft assembly 21 comprises an outershaft 20, a cutting member 60 slidably disposed therein and a fitting 50disposed on the distal tip. Referring now to FIG. 1, the outer shaft 20further includes an opening 23 formed in the side thereof adjacent tothe distal tip. The proximal end of the shaft assembly 21 is receivedwithin a housing 30. The housing further including a biasing member 65and a cutting member actuating device 40. The biasing member 65 isoperatively coupled to the cutting member 60, thereby retaining thecutting member in a retracted position. The cutting member actuatingdevice 40 advances the cutting member 60 within the bore of the shaft,wherein the cutting member extends to cover the opening formed in theside of the shaft and to sever suture projecting therefrom.

As shown in FIG. 5, the cutting member 60 may comprise a semi-circularor circular member disposed about the protrusion 54 of the fitting 50.Referring now to FIG. 2, the cutting member 60 includes a proximal end62 and a distal end 61, the distal end being configured to sever suture.As shown in FIG. 2, a bushing 67 is disposed about the proximal end 62of the cutting member 60. The bushing 67 retains the biasing member 65within the housing 50. The bushing further includes at least oneprotrusion 68 extending therefrom and perpendicular to the axis of theshaft. The protrusion 68 is configured to engage the cutting memberactuating device 40 disposed within the housing 50 as shown in FIG. 3.

Referring now to FIG. 3 there is shown the suture trimmer 10 inaccordance with the present invention wherein the cutting memberactuating device 40 has been actuated, thereby advancing the distal endof the cutting member across the opening 23 of the shaft 21. As shown inFIGS. 2 and 3, the cutting member actuating device 40 has a proximal endand a distal end. The proximal end being configured to engage theprotrusions 68 extending from the bushing 67. The distal portion of theactuating device 40 may include a depressed or sculpted area configuredto receive a user's finger, thereby providing a more positive grip onthe actuating device. The actuating device 40 further includes a pivotpin 45. The pivot pin 45 is adapted to engage a portion 35 of the mainhousing 30, wherein the portion 35 of the main housing rotatablyreceives the pivot pin 45 thereby allowing the actuating device 40 topivot about the portion 35.

Referring now to FIG. 4, there is shown an exemplary embodiment of thefitting 50 in accordance with the present invention. The fitting 50includes distal end portion 51 having a protrusion 54 extendingtherefrom, the protrusion forming a proximal end portion 52. Theprotrusion further includes a skive or relieved area 53 formed adjacentto the distal end portion. An aperture 55 is formed axially within thedistal end portion 51, wherein the aperture 55 is in communication withthe skive 53. As described above, the end portion of the distal end 51is configured to engage the knot and permit smooth advancement of theknot. The fitting 50 is typically a cylindrical element having a flat orslightly convex or concave front face. In an alternative embodiment, theface may be disposed at an angle relative to the axis of the shaft. Thedistal end 51 of fitting 50 preferably has a diameter equal to or lessthan the diameter of the shaft.

Referring now to FIG. 5 there is shown a cross sectional view of theshaft assembly 21 in accordance with the present invention. As shown,the shaft assembly comprises the outer shaft 20, the cutting member 60,and the protrusion 54 of the fitting 50. Although the elements are shownand described as being co-axially arranged, it is contemplated that theelements may be disposed in any manner within the outer sheath.Furthermore, it is contemplated that the outer sheath may be embodiedhaving different geometric shapes such as oval, square, or generallycircular as shown.

Referring now to FIG. 6, there is shown a suture snare in accordancewith the present invention. The suture snare comprises a housing and asnare extending therefrom. As shown in FIGS. 1 and 6, the housing 92 hasa proximal end and a distal end and is configured to be detachablyattached to the shaft 20 of the suture trimmer 10. The snare 95 extendsfrom the distal end of the housing 92. As shown the distal tip portionof the snare 95 is configured having a diamond shape, though many othergeometric shapes may be utilized and the use of a diamond shaped distaltip shall be considered exemplary. The snare may be constructed ofmaterials such as metal or plastic. Examples of suitable metals arestainless steel, copper, steel, titanium, platinum or nickel-titanium.Alternatively, a non-bio-compatible material may be utilized wherein thenon bio-compatible material is then coated with a bio-compatible coatingsuch as gold or silver. Examples of plastics that may be utilized arePVC, polyurethane, and similar plastics. In a preferred embodiment thesnare is constructed of nickel-titanium wire. The use of nickel-titaniumenables a larger distal end portion 92 than if conventional materialsare utilized. Furthermore, the nickel-titanium will not deform or becomedeformed in normal use because of the shape memory characteristics ofthe material. The use of a larger distal section on the snare providesfor easier loading of the sutures therein.

Referring now to FIGS. 7-10 there is shown the suture trimmer 10 inaccordance with the present invention in use. As shown in FIG. 7, asuture loop including a knot has been formed in a vessel wall of apatient, the vessel wall having an opening, or arteriotomy, as a resultof a medical procedure, for example. The two free ends of the suture areplaced within the distal end portion 95 of the suture snare 90, whereinthe distal end 95 of the snare has been disposed through the skive 23and the aperture 55. The housing 92 being detachably mounted to theshaft 20 of the suture trimmer is removed from the shaft 20 and using afree hand the distal end of the snare 95 is drawn through the aperture55 and the skive 23. As the snare is drawn through aperture and skive,the free ends of the suture S are additionally drawn through as shown inFIG. 8.

Referring now to FIG. 9 there is shown the end portion of the fittingcontacting the knot K, wherein the knot is then advanced to the wound.One free end of the suture S is held tight to withdraw slack from thesuture loop. The end portion of the fitting is utilized to place theknot tightly against the tissue, after the knot has been placed, thesecond free end of the suture S′ is tensioned, thereby locking the knot.

Referring now to FIG. 10, the two free ends of the suture S and S′ aretaken into a free hand, the proximal end of the cutting member actuatingdevice 40 is pressed, thereby pivoting the actuating device about thepivot pins. The surgeon then applies a force to the distal end of theactuating device. The applied force is transmitted through the actuatingdevice to advance the cutting member from a retracted position withinthe shaft to an extended position as shown. The two free ends of thesuture are then severed by the sharpened distal tip 61 of the cuttingmember 60 when the distal tip 61 of the cutting member contacts thefitting 50 distal the opening 23. The suture trimmer and the excesssuture is then withdrawn from the tissue path, sheath, or cannulathereby leaving a suture loop having a knot and shortened suture tipsextending from the knots. It is contemplated that the trimmed suturetail will have a length of about 1 mm to about 10 mm, more preferablybetween about 3 mm and about 7 mm is preferred to minimize the risksassociated with lengths of suture that remain within the body asdescribed above.

Although the present invention has been described in considerable detailwith reference to certain preferred embodiments, it is contemplated thatone skilled in the art may make modifications to the device hereinwithout departing from the scope of the invention. Therefore, the scopeof the appended claims should not be considered limited to theembodiments described herein

What is claimed is:
 1. A method for closing a tissue puncture, themethod comprising: advancing two free ends of a suture through a suturesnare, the suture snare selectively attachable to a shaft and the suturehaving a knot disposed on one of the free ends of the suture; followingadvancing the knot disposed on one of the free ends and detachment ofthe suture snare from the shaft, advancing a cutting member along thesuture towards the knot, the cutting member selectively movable betweena first position and a second position, the second position positioninga distal end of the cutting member distal the first position; andactivating the cutting member to cut the two free ends of the sutureadjacent to the knot.
 2. The method of claim 1, further comprisingtensioning a suture loop disposed within a vascular tissue of a patient,the suture loop having the two free ends.
 3. The method of claim 1,wherein the suture snare comprises a snare body and a snare extendingfrom the snare body.
 4. The method of claim 3, wherein the snare has adiamond shape with a distal end larger than a proximal end.
 5. Themethod of claim 1, wherein advancing the knot comprises advancing theshaft towards the tissue puncture along one of the free ends.
 6. Themethod of claim 5, wherein the shaft comprises a distal end, a proximalend, and a lumen extending therebetween.
 7. The method of claim 5,wherein the shaft is part of a suture trimmer.
 8. A method for closing atissue puncture, the method comprising: tensioning a suture loopdisposed within a vascular tissue of a patient and having two free endsand a knot disposed on one of the free ends; disposing the two free endsof the suture through a suture snare comprising a snare; followingdetachment of the suture snare from the two free ends, advancing theknot disposed on one of the free ends to close the suture loop; slidablyadvancing a cutting member along the two free ends towards the knot, thecutting member selectively movable between a first position and a secondposition, the second position positioning a distal end of the cuttingmember distal the first position; and activating the cutting member tocut the two free ends of the suture adjacent to the knot.
 9. The methodof claim 8, wherein slidably advancing a cutting member furthercomprises advancing a suture trimmer having a shaft with an openingformed in a side adjacent a first end of the shaft.
 10. The method ofclaim 9, further comprising extending the snare through the opening ofthe shaft.
 11. The method of claim 10, advancing the snare through theopening of the shaft so as to pull the two free ends of the suturethrough the opening of the suture trimmer.
 12. The method according toclaim 9, wherein the suture trimmer further comprises a fitting disposedon the first end of the shaft, the fitting having a channel formedtherethrough, the channel being axially aligned with a lumen of theshaft adjacent the first end and in communication with the openingformed in the shaft, the fitting further including a flexible protrusionextending through the lumen of the shaft and connected to a housing, thesnare extending through the channel of the fitting.
 13. The methodaccording to claim 8, wherein advancing the knot to close the sutureloop comprises advancing the knot through an intravascular tissue tracttoward the suture loop anchored in the vascular tissue.
 14. The methodaccording to claim 12, wherein the vascular tissue is located adjacent avascular structure selected from the group consisting of a patentforamen ovale, a mitral valve, a tricuspid valve, a pulmonary valve, acoronary artery bypass graft, and an aortic valve.
 15. The methodaccording to claim 8, wherein tensioning a suture loop comprisesgrasping a free end of one of the two free ends in one hand.
 16. Themethod according to claim 8, wherein the suture snare further comprisesa housing from which the snare extends, and wherein detachment of thesuture snare comprises detaching the housing of the suture snare andpulling the housing of the suture snare away from the two free ends. 17.A method for closing a tissue puncture, the method comprising tensioninga suture loop disposed within a vascular tissue of a patient and havingtwo free ends and a knot disposed on one of the free ends; disposing thetwo free ends of the suture through a suture snare comprising a housingand a snare extending from the housing; following loading the two freeends to advance the knot, advancing the knot disposed on one of the freeends to close the suture loop; slidably advancing a cutting member alongthe two free ends towards the knot, the cutting member selectivelymovable between a first position and a second position relative to aside opening of a shaft through which the two free ends extend, thesecond position positioning a distal end of the cutting member distalthe first position and closing the side opening; and activating thecutting member to cut the two free ends of the suture adjacent to theknot.
 18. The method of claim 17, wherein advancing the knot furthercomprises advancing a first end of the shaft to contact the knot andadvance the knot to close the suture loop while holding at least one ofthe two free ends.
 19. The method according to claim 17, whereinadvancing the knot comprises advancing the knot through an intravasculartissue tract toward the suture loop anchored in the vascular tissue. 20.The method according to claim 19, wherein the vascular tissue is locatedadjacent a vascular structure selected from the group consisting of apatent foramen ovale, a mitral valve, a tricuspid valve, a pulmonaryvalve, a coronary artery bypass graft, and an aortic valve.